Transcript malnutrition in children by Allison Schmale

Allison schmale 59054563
Children and Malnutrition
Allison Schmale, PCV
Introduction
• Qualifications: Bachelor of Science in Nutrition
and Dietetics from St. Louis University
• Objectives
– Identifying Malnutrition in Children
– Meal Planning for Malnourished Children
– Budgeting for Cost Effectiveness
– Practicing Food Safety
Protein Energy Malnutrition
• Protein Energy Malnutrition/Undernutrition
(PEM/U) results from lack of food or an
infection, causing lack of appetite, often
occurring in children between the ages of 6
months and 5 years in developing countries.
Marasmus
• Marasmus is a type of PEM resulting from long
term starvation or chronic infections causing
small food intake.
• A defining sign is a “skin pulled over bones”
look to the child with little to no fat present
along with severe wasting of shoulders, arms,
buttocks and thighs, and visible rib outlines.
– Wasting: Involuntary weight loss and loss of lean
body mass and fat
Marasmus, Continued
• Physical Signs of Marasmus:
– Thin, “wizened” face
– “Baggy Pants”-Loose skin of the buttocks hanging
and flabby
– Noted Alertness in Children
– No Edema in the lower limbs
• Edema: Fluid pooling under the skin because of poor
nutrition, often in the stomach or extremities. Causes a
pit or indent when pressure is applied.
– Ribs are Very Prominent
Kwashiorkor
• Kwashiorkor occurs when children get enough
food, but not enough protein to support proper
growth. This usually occurs in children from 1-4
years.
• Edema is the main sign that indicates
Kwashiorkor and helps you to distinguish it from
Marasmus.
– Edema may cause the child to look fat and well fed
– Edema can be identified, when applying moderate
pressure for 3 seconds and a definite pit results.
Kwashiorkor, continued
• Physical Signs of Kwashiorkor:
– Edema in stomach or extremities.
– Hair changes: loss of pigmentation (dark hair gets a red or
orange tint) and curly hair becomes straight and is easily
plucked.
– Skin changes: sores and patches of darker or lighter skin
– Children can become apathetic, miserable, and irritable. They
often show no signs of hunger and it can be difficult to get them
to eat
• Not all symptoms always occur, however edema usually is
there while others are not.
Marasmic Kwashiorkor
• This is a mix of both types of PEM and the
general signs are edema along with other
signs of Kwashiorkor.
Initial Refeeding
• First any underlying problems must be addressed
• Special care must be taken when refeeding
severely malnourished children in order to
prevent refeeding syndrome.
– Refeeding syndrome results from over-aggressive
introduction of nutrients after chronic malnutrition,
causing an imbalance of electrolytes in the body
which can result in cardiac and pulmonary
complications.
• To avoid refeeding syndrome give moderate
carbohydrates and adequate electrolytes (as in
ORS)
As feeding continues…
• Initially the child should have less and less diarrhea
until it completely goes away
• Edema should begin to go away
• Appetite should return
• Do not allow children to consume huge amounts, but
rather give them small amounts of nutrient dense food
frequently
• First introduce carbohydrates and work in other food
groups like protein and fats and fruit and vegetables as
the child continues to eat more. This is easier on their
digestive systems and helps their gastrointestinal tract
to get back in working order.
Meal Planning for Children
• If severe malnutrition is present, moderate amounts
of food should be given, beginning with
carbohydrates and slowly integrating small servings
of protein, fats, and fruits and vegetables given in
small, frequent meals.
• It is very important that the children get adequate
protein. If malnutrition is present and severe, the
child will not be able to make up for their lack of
mental development, but adequate amounts of
protein will help with further physical development.
Meal Planning for Children, continued
• Once the child is getting adequate and
consistent amounts of food, other
deficiencies, like kwashiorkor or pellagra,
should go away with the introduction of the
necessary nutrients.
• The most important part of a child’s diet is
that they get enough protein everyday,
without protein they cannot further
development both mentally and physically.
Meal Planning for Children, continued
Meal Planning For Children, continued
• Notes on Previous Slide
– Carbohydrates do not dominate the plate, it is
important they are in proportion with other
nutrients on the plate, especially if the child is
recovering from severe malnutrition.
Meal Planning for Children, continued
– Protein takes up at least one third of the plate, it
should always be present and should not be replaced
or omitted, avoid dairy here in the initial phases of
refeeding a severely malnourished child because the
child has difficulty digesting diary initially and dairy
should be slowly reintroduced into the diet to prevent
further complications.
– Vegetable servings can be made up of several
vegetables, the more variety on the plate the more
nutrients the child will get
Recipe Analysis for Children
• Standard Menu for Lunch or Dinner:
– 1 cup papa
– ¼ cup meroho
– ¼ cup eggs
• While this menu does supply protein and
vitamins and minerals it can be improved by
enriching it and adjusting the proportions
Recipe Analysis for Children, continued
• Improved Menu
– 1 cup papa => ½ cup papa made with milk
– ¼ cup meroho=> ¼ cup spinach, carrots, and onion
¼ cup pumpkin, all made with
minimum salt/Aromat
– ¼ cup eggs=> 1egg scrambled or hard boiled
(approximately ½ cup)
• This allows the child to get more nutrition out of
their meal and supplies all nutrients in adequate
amounts along with a variety of foods.
Enriching Foods
• The best way to enrich foods is to add milk or
eggs because they are a very good source of
protein and vitamins as well as inexpensive.
• Milk and eggs can be added to breads, papa,
porridge, and samp.
• Foods, like porridge and bread, can also be
enriched using pumpkin seeds or beans which
add protein and calories to foods.
Enriching Foods, continued
• This enrichment will help the food to be more
filling and gets more protein into the child.
• When cooking eggs you can also add
vegetables to the eggs in order to get more
vegetable servings in a meal.
• If a child is not eating well and is lacking in
appetite, add extra oil in the food to make up
for calories lost because of small intake.
Food Comparisons-Which food is
better?
• Carbohydrates:
– The less the grain has been processed the better it
is for you. Ex: wheat/brown bread is better for
you than white bread.
– Rice, in full grain form is, better than papa
(unenriched) because it too provides protein and
has not been as processed as the papa.
– Keep to the rule that the whole grains, or the
closer to it, is better than those that have been
processed or are white.
Food Comparisons-Which food is
better? continued
• Proteins:
– Eggs are one of the best sources of protein because
the protein in eggs is very biologically available
(meaning our bodies can use it easily with little to no
waste)
– Dairy is also a good source of protein, but should not
be given to children recovering from malnutrition
initially because the digestive system is not ready to
digest lactose (the sugar in dairy) yet.
– Non-animal sources also supply good protein when
paired with the right carbohydrate.
• Example: beans and rice, peanut butter and bread
Food Comparisons-Which food is
better? continued
• Vegetables and Fruits:
– Raw vegetables are best because all of the
nutrients are still intact
– Vegetables should only be cooked until they are
just done to avoid overcooking, which destroys
nutrients
– A minimal amount of oil and salt should be used
Food Comparisons-Which food is
better? continued
– Colorful vegetables are more nutritious than
others. For example: spinach has more nutrients
than potatoes, pumpkin has more nutrients than
corn/maize.
– Eat a variety of colors means you are getting more
variety in the meal because different colors
represent different nutrients.
– Fruits should be used instead of snack foods like
simbas or desserts. Fruits also supply a good
source of fiber and other nutrients
Food Costing
• With your budget, you have to find out how
much you can spend on each child per day.
• Then from there you can develop a menu to fit
your budget for each child.
• Careful planning needs to go into planning the
menu and the budget needs to be followed
exactly in order for it to be effective.
Food Costing, continued
• Tips:
– Buy in bulk
– Use standardization of recipes and servings (use
the same amount every time and give out the
same amounts for the children)
– Take advantage of complimentary proteins to save
money by serving meat or eggs every few days
and beans and papa on other days
Food Costing, continued
– Grow your own food-have a garden, have layers
for eggs, have a milking cow for milk, etc
– Buy food locally, from other households and local
shops because you will save on transport, support
local businesses in your area, and the vegetables
will be healthier because they are fresh
Basics to Food Safety
• Food safety is very important and should be
practiced every time you handle food.
• There are four simple steps to food safety and
sanitation:
– Clean
– Separate
– Cook
– Chill
Basics to Food Safety, continued
• Cross contamination is when the harmful bacteria on
food, cutting boards, utensils, surfaces or hands
contaminates (or gets onto) another food.
• This is prevented by separating food and by keeping
your hands, utensils and food handling surfaces clean.
• Food preparation puts the food’s safety completely in
your hands, making you responsible for preparing
quality and safe food to eat.
• This starts with using clean preparation methods and
cooking food to the right temperatures.
• This starts with proper hand washing.
Basic to Food Safety, continued
• Unclean surfaces and utensils are often the cause of “crosscontamination.”
• It is especially important to keep raw foods, like raw meat,
poultry, fish and their juices away from other foods.
• Wash cutting boards, surfaces, and countertops with hot,
soapy water after you prepare each item and before
moving on to the next.
– This is extremely important when handling raw meat, poultry,
fish, and seafood.
• Cooking food to a safe temperature is the best way to make
it safe, to make sure it is safe, there are temperatures that
food should be cooked to, to destroy any harmful bacteria
that may be in the food.
Basics to Food Safety, continued
• When serving food:
– Keep hot food hot and cold food cold so the food
doesn’t reach a temperature where bacteria can grow
– Keep everything clean by washing your hands, wash
utensils and dishes, keep food separate using plastic
wrap and sealed containers, bring water and soap
with you if there is no running water to wash things
up
• Wash dishes is warm soapy water and allow to sit
in a solution of 1 tbsp bleach to 2 liters of water
for a few minutes to ensure all the bacteria have
been killed and the dishes are safe to use
Recipe Suggestions
• Omelet (for four people)
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8 eggs (two per person served)
Tomato, chopped
Onion, chopped
Green pepper, chopped
Spinach, chopped
Salt and pepper
2 tbsp Cooking oil or margarine, or more if needed
Beat eggs and add salt and pepper
Heat margarine or oil in pan, when hot pour in the eggs and stir.
When the mixture set, tilt the pan back so the uncooked portion will flow
under the cooked portion. Continue this way until all is set and has light
brown color underneath.
– Add tomato, green pepper, spinach, and onion to one half and fold over.
– Serve immediately.
Recipe Suggestions, continued
• Spinach Fat Cakes
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4 cups spinach
2 ½ cup flour
1 tsp Salt
2tsp Barbecue Spice
2 egg
Cooking oil
Chop spinach
Stir together flour, salt, barbecue spice then add eggs and
then add spinach.
– Heat oil in a pan and drop about a handful size of spinach
mixture into pan and fry until golden brown on both sides.
Recipes Suggestions, continued
• Bean Soup
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2 cups beans
1 cup potatoes
1cup carrots
1 green pepper
2 tomatoes
1 onion
2 tbsp cooking oil
2 tsp barbecue spice
2 tsp white pepper
2 tsp salt
Water
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Cook beans until they are soft
Chop carrots, potatoes, tomatoes and green pepper
Fry onion
Mix together, and simmer until soft, stirring constantly
Allow to simmer until vegetables are soft
Recipe Suggestions, continued
• Vegetable soup
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1 cup potatoes
1 cup spinach
1 cup carrots
2 tomatoes
1 tbsp cooking oil
½ tsp salt
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Wash, peel and cut up vegetables into small pieces
Cook carrots until soft, then add to vegetable mixture
Simmer until soft
Serve while warm
Recipe Suggestions, continued
• Pumpkin Soup
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2 medium onions
1 tbsp flour
1 cup milk
2 tbsp margarine
2 cups chicken broth
3 cups pumpkin puree
Salt and Pepper to taste
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Sautee onions in margarine
Sprinkle flour over onions, stir and cook for 5 minutes
Gradually add chicken broth and milk stirring constantly
Add pumpkin puree and cook on low heat for 15 minutes
Add salt and pepper to taste
Recipe Suggestions, continued
• Sechu (Mixed Vegetables)
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1 cup spinach
1 cup carrots
1 cup potato, cooked
1 onion, chopped
2 tomatoes
1 green pepper
2 teaspoons barbecue spice
2 teaspoons white pepper
Salt to taste
Cooking oil
Cook potato by boiling in water until soft.
Chop all vegetables into small pieces
Sautee onion and green pepper in oil, then add carrots and cook until soft.
Then add all the rest of the vegetables and seasonings, toss together in pan.
– Take off heat and serve immediately.
Recipe Suggestions, continued
• Improved Porridge with Egg
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1 cup sorghum meal
1 cup milk
1 egg
2 cups water
2 tsp sugar
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Boil water
Mix flour with milk and sugar
Gradually add the milk and egg to mixture, while stirring
Simmer for 15 minutes
Recipe Suggestions, continued
• Porridge with Milk
– 1 cup maize meal
– 3 cups milk
• Add half cup milk to pan, then add second half once
brought to boil
• Mix and let simmer
• Cook 20 minutes
Recipe Suggestions, continued
• Bean Porridge
– 2 tbsp maize meal, sorghum meal or wheat meal
– 1 cup cooked beans or peas
– Water
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Mast the beans or peas, then sieve them
Cook the soft porridge
Add sieved beans to soft porridge, then let simmer
Remove from heat, cool
Sources
• “Protein Energy Malnutrition.”
www.emro.who.int/nutrition/pdf/protein_mal
nutrition.pdf. May 18, 2009.
• Mahan, L. Kathleen and Stump, Sylvia EscottStump. Krause’s Food and Nutrition Therapy.
12 ed. Saunders Elsevier, St. Louis. 2008.